Medical Benefits

As a Blue Cross Community Health Plans member, you have access to medical, dental, vision, behavioral health, prescription drug coverage and more. Some special benefits include:

Zero co-pays: You pay nothing ($0) when you go to a doctor or health care provider in the plan's network.

24/7 Nurseline: If you have questions, our nurses have answers. This help line is staffed all day, every day with registered nurses. If you have an unexpected medical situation, call the Nurseline at 1-888-343-2697. A nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem at home.

Blue365®: Save money on health and wellness products and services through this online discount program. Sign up for email alerts to see new offers.

CO-PAY

BENEFIT LIMIT/EXCLUSIONS

• Every two (2) years for member age 21 and older
• Replaced "as needed" for members under 21
• Additional reimbursement toward a pair of upgraded eyeglass frames

• Contact lenses when medically necessary

REQUIRES PRIOR AUTHORIZATION?*

Yes

*Services must be medically necessary. Some services need approval from your health plan before you get treated. This approval is called "prior authorization." Your doctor should know which services need approval and can help with the details. †Some limits apply to general dentistry.

For a complete list of covered services and to learn about coverage decisions, see the Member Handbook.

What is not covered?

Some services that are not covered include:

Cosmetic surgery or treatment that are not medically necessary

Procedures that are still being tested or experimental

Services by non-licensed providers

Drugs and supplies without a prescription

Acupuncture

Services in an emergency room for health issues that are not emergencies

Coverage Decisions

Blue Cross Community Health Plans has strict rules about how decisions are made about your care. Our doctors and staff make decisions about your care based only on need and benefits. There are no rewards to deny or promote care. Blue Cross Community Health Plans does not encourage doctors to give less care than you need. Doctors are not paid to deny care.

If you want to know more about the utilization management process or how decisions are made about your care, contact Member Services at 1-877-860-2837 (TTY/TDD 711).